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Date., ...I......... ..-...1.. ........
TOWN OF NORTH ANDOVER
PERMIT FOR WIRING
This certifies that ..................... // �Z: �
�. ry...........................'....................74 .....................................
has permission to perform ..,y:..... .
wiring in the building of.......................................................................
at ..... ...............y% �'... �!..":':....�'� a /� ., North ndover, Mass.
,f ..... .............. r
t�Fee....�s..:............ Lic. No. 2 j C�..�� ..fl' �:�................................................
ELECTRICAL INSPECTOR
Check #
1.3005-//
commonwealth of Massachusetts official Una Only
Department of Fire Setyices Permit No.
BOARD OF FIRE PREVENTION REGULATIONS
. APPLICATION FOR -PERMIT TO PERFORM ELECTRICAL
WORK
Au work to be performed iu R=4=ce with the Massa&uset Blear' Code 527 Oa 12.00
(pLWEpna17VMOlt ?YPEALIWOR MAT70M Date: � V17116
/6
City or Town of: lc .� TO the Inspector of Wires:
By this application the undersigned gives notice of his or bar intention to perform ii:e electrical work descnbed below.
Location (Street & Number; c/
Owner or Tenant ► Telephone No.
Owner's Address
Is this permit is conj unction with a bA. ding permit? Yes ❑ ' No 19Bnilding Permft #
Purpose of Building Utility Authorization No.
Big Service 610 Amps f?c) !'`� Volts Overheads Undgrd ❑ No. of Meters _!
ftwJoQ Amps kk) 1f0 volts Overhead ] Uudgrd (] No. of Meters
Number of Feeders and. Ampacity
Location and
"b�4 ',- -)
of proposed Electrical Worla
-- tenon Art" ollawta tableMA be waivedby the lw=W of Wires
No. of Recessed Fbdures
No. of CeiL-%*. (Paddle) Fans
No. Of raw
Transformers KVA
Na of Lighting Outlets
No. of Hot Tubs
Generators KVA
Na. of Mgh ft Flifiv a
AboveNo.-oTXWrgenCY
8w3mmiag P0W trod,D
L11 j
D &g tJuPtg
No. of Receptacle Outlets
No. of OR Burners
FM ALARMS IN0. of Zones
Na of Switches _
No. of Gas Burners
o. o on ana
vi
YaitiaDevic
No. of Ranges
Total
No. of Air Cond.
ofrting Devices
joleoet;�gt)
Na of Waste D osers
er ons
Totals: ""-""� "
Ale Devices
o�P
No. of Dishwashers
SpacelArea Heating KW
Locai ❑ Connection ❑ Other
No. of Dryers
Heating Appliances KWSecurit
ms'
No. of k4ew or Equivalent
No. stet-
Heaters KW
NO. o•
S' s Ballasts
Data.Witing:
No. of Devices or E uivaient
'Telecomm
No. Hydromassage Bathtubs
Na of Motors Total HP
. o f D ��
No. of Devlees or ent
OTHER.
. r ALL r _tets,.�:..e1 tsur�t *r►stvicf011N 1ffiTE3S
INSURANCE COVERAGE Unless=wMea oy idle owner' uo Peri. An mr, jJGJ.iwiliRtlK.
Ow licensee provides proof of liability insurance imelnding "complettd operation" coverage or its substantial equivalent. The
mWasigeed certifies ftt such coverage is in force, and has eulubited proof of same to the permit issuing office-
CHEM
ONE: INSURANCOKI BOND ❑ OTHER ❑ {specify:) mon pace)
Esdmated Valu of •cal work ' (w>aeti zequinea by nrtmicipat policy:)
Work to Start: Inspections to be requested in accordance with MBC Rule 10, and upon completion
Icaftw1der the pains and penawa of perjury, that the informadon on this application is &W and complete: Current
Ltsur=" Qerj#iaete mint 6e on fixe to our ope ArAwaZw he,idled drat *pith each Wfia WOW
FIRM NAME: � Z � /1Lle LIC. NO.: i6iS
Licenses:.cl %-%-n�� Si LIC. NO.:
(If aPP enter " :.. in license manber ) Bus. Tel. No.;'�`''��a
Address: il/ P✓tr / d1 S Alt. TeL No.:
O g'S WAIVER: I am aware that ft Licensee does not have the liability insurance coverage normally
required by law. By my signature below, I hereby waive this rent. I am the (check one owner owner's cmt.
Owner/Agent Telephone No. PERMIT FEE: $�